Individual
DR. THERESA M DERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8040 PRINCETON-GLENDALE RD., WEST CHESTER, OH 45069-0000
(513) 872-2000
(513) 281-8842
Mailing address
4685 FOREST AVE STE C, CINCINNATI, OH 45212-3359
(513) 246-7796
(513) 852-8525
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35088598
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2704836
—
OH
Enumeration date
09/28/2006
Last updated
10/02/2014
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